What Causes Pituitary Apoplexy?

Major Surgery

Any major surgical procedure can cause pituitary apoplexy due to surgical stress. Surgical stress describes when the injuries incurred to the patient's tissues during surgery can cause their sympathetic nervous system to become activated. The activation of the sympathetic nervous system produces hematological changes, immunological changes, and endocrine responses. These endocrine responses include an abnormal stimulation of the patient's pituitary gland that puts it under extreme pressure to produce excess amounts of steroids. In most surgical environments, surgical stress is well managed by the anesthesiologist and surgical team, but this management is not always effective for each patient. Other surgical procedures can also produce pituitary apoplexy through different mechanisms that are the result of changes in the patient's blood pressure and intracranial pressure. These changes can produce a bleed that precipitates pituitary apoplexy. Such procedures include angiography, myelography, spinal anesthesia, pneumoencephalography, and lumbar puncture.

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